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Item Declining Tuberculosis Incidence Among People Receiving HIV Care and Treatment Services in East Africa, 2007–2012(Lippincott, Williams, and Wilkins, 2016-04) Saito, Suzue; Mpofu, Philani; Carter, E. Jane; Diero, Lameck; Wools-Kaloustian, Kara K.; Yiannoutsos, Constantin T.; Beverly, Musick S.; Tsiouris, Simon; Somi, Geoffrey R.; Ssali, John; Nash, Denis; Elul, Batya; Department of Medicine, IU School of MedicineBackground: Antiretroviral therapy (ART) reduces the risk of Tuberculosis (TB) among people living with HIV (PLWH). With ART scale-up in sub-Saharan Africa over the past decade, incidence of TB among PLWH engaged in HIV care is predicted to decline. Methods: We conducted a retrospective analysis of routine clinical data from 168,330 PLWH receiving care at 35 facilities in Kenya, Tanzania, and Uganda during 2003–2012, participating in the East African region of the International Epidemiologic Databases to Evaluate AIDS. Temporal trends in facility-based annual TB incidence rates (per 100,000 person years) among PLWH and country-specific standardized TB incidence ratios using annual population-level TB incidence data from the World Health Organization were computed between 2007 and 2012. We examined patient-level and facility-level factors associated with incident TB using multivariable Cox models. Results: Overall, TB incidence rates among PLWH in care declined 5-fold between 2007 and 2012 from 5960 to 985 per 100,000 person years [P = 0.0003] (Kenya: 7552 to 1115 [P = 0.0007]; Tanzania: 7153 to 635 [P = 0.0025]; Uganda: 3204 to 242 [P = 0.018]). Standardized TB incidence ratios significantly decreased in the 3 countries, indicating a narrowing gap between incidence rates among PLWH and the general population. We observed lower hazards of incident TB among PLWH on ART and/or isoniazid preventive therapy and receiving care in facilities offering TB treatment onsite. Conclusions: Annual TB incidence rates among PLWH significantly declined during ART scale-up but remained higher than the general population. Increasing access to ART and isoniazid preventive therapy and co-location of HIV and TB treatment may further reduce TB incidence among PLWH.Item Lower extremity weakness: A rare case of extrapulmonary tuberculosis(Elsevier, 2019-01) Rijal, Suraj; Adhikari, Sunil; House, Darlene R.; Emergency Medicine, School of MedicineItem Management of Arthritis(Association of Kenya Physicians, 2007) Association of Kenya Physicians Scientific Conference (11th : Mar. 2007 : Eldoret, Kenya)Item Middle East Respiratory Syndrome Coronavirus and Pulmonary Tuberculosis Coinfection: Implications for Infection Control(Karger, 2017-10) Alfaraj, Sarah H.; Al-Tawfiq, Jaffar A.; Altuwaijri, Talal A.; Memish, Ziad A.; Medicine, School of MedicineCoinfection of Middle East respiratory syndrome coronavirus (MERS-CoV) with tuberculosis (TB) has not been previously reported. Here, we present 2 cases with both MERS-CoV and pulmonary TB. The first case was a 13-year-old patient who was admitted with a 2-month history of fever, weight loss, night sweats, and cough. The second patient was a 30-year-old female who had a 4-week history of cough associated with shortness of breath and weight loss of 2 kg. The 2 patients were diagnosed with pulmonary TB and had positive MERS-CoV. Both patients were discharged to complete their therapy for TB at home. It is likely that both patients had pulmonary TB initially as they had prolonged symptoms and they subsequently developed MERS-CoV infection. It is important to carefully evaluate suspected MERS-CoV patients for the presence of other infectious diseases, such as TB, especially if cohorting is done for suspected MERS-CoV to avoid nosocomial transmission.Item Saving Children From the White Plague: The Marion County Tuberculosis Association's Crusade Against Tuberculosis, 1911-1936(2010) Gascoine, Kelly Gayle; Schneider, William H. (William Howard), 1945-; Barrows, Robert G. (Robert Graham), 1946-; Jay, Stephen J.In 1910, tuberculosis ranked as the leading cause of death in Indianapolis. A year later in 1911 physicians and lay members of the Marion County public joined the burgeoning American anti-tuberculosis movement. These men and women formed a voluntary health organization to combat the disease called the Marion County Tuberculosis Association (MCTA). The MCTA ran a variety of public education campaigns to teach people of all ages about the causes of, treatments for, and proper preventive measures to take against tuberculosis. It lobbied Indianapolis and Marion County governments to open TB clinics and a county tuberculosis sanatorium so that consumptives, as tuberculosis patients were called, had access to medical care and so that the spread of the disease could be checked. The organization also cooperated with other groups to fight tuberculosis including local agencies, the Indiana Board of Health, the Indiana Tuberculosis Association (ITA), and the National Tuberculosis Association (NTA). One aspect of the MCTA’s activities came to dominate its mission and resources within a few years of its establishment, that of child health education. In this emphasis the association differed from other organizations in the anti-tuberculosis movement that recognized the need to improve child health but never designated it as the number one priority like the MCTA. This thesis will examine the first twenty-five years of the MCTA to analyze how and why the organization elevated child health and child health education to such a high priority as a means of controlling and eradicating tuberculosis in Indianapolis and Marion County.Item A Systematic Review of Clinical Diagnostic Systems Used in the Diagnosis of Tuberculosis in Children(2012-05) Pearce, Emily C; Woodward, Jason F; Nyandiko, Winstone M; Vreeman, Rachel C; Ayaya, Samuel OBackground. Tuberculosis (TB) is difficult to diagnose in children due to lack of a gold standard, especially in resource-limited settings. Scoring systems and diagnostic criteria are often used to assist in diagnosis; however their validity, especially in areas with high HIV prevalence, remains unclear. Methods. We searched online bibliographic databases, including MEDLINE and EMBASE. We selected all studies involving scoring systems or diagnostic criteria used to aid in the diagnosis of tuberculosis in children and extracted data from these studies. Results. The search yielded 2261 titles, of which 40 met selection criteria. Eighteen studies used point-based scoring systems. Eighteen studies used diagnostic criteria. Validation of these scoring systems yielded varying sensitivities as gold standards used ranged widely. Four studies evaluated and compared multiple scoring criteria. Ten studies selected for pulmonary tuberculosis. Five studies specifically evaluated the use of scoring systems in HIV-positive children, generally finding the specificity to be lower. Conclusions. Though scoring systems and diagnostic criteria remain widely used in the diagnosis of tuberculosis in children, validation has been difficult due to lack of an established and accessible gold standard. Estimates of sensitivity and specificity vary widely, especially in populations with high HIV co-infection.